Santa Cruz, Calif.: My friend was diagnosed with a chronic illness about 15 years ago. She takes care of herself and has learned to live with her condition. She remained active and always appeared healthy. Two years ago, she discovered that she has food allergies that are the cause of her health problems. She was disappointed that she would have to live on an extremely restricted diet but hopeful that her body might recover once the allergens were out of her system.

Since she started the new diet, the results have been dramatic. She looks sick. She is underweight, pale, and always tired. She also has gastrointestinal problems which she never complained about before the diet. And she still suffers from the original condition. If I ask how her diet is going, she says she feels great and she’s happy she is no longer poisoning her body. Should I let her know what I’m observing? I don’t want to pry, but should I ask more about what kind of medical care she is getting?

Emily Yoffe: It’s possible your friend is not seeing a quack, but I would bet she is. I’d also bet she is paying a lot of money to the doctor who diagnosed her “allergies.” I wouldn’t be surprised if this doctor sold supplements or special diet food to keep her “healthy.” It is strange that people will ignore the signs that a treatment is making them worse because they want so much to believe. You could try to do some research on the doctor and the diagnosis. I’m sure you can turn up evidence that questions the supposed food allergies. But even in the absence of that, you should express your concern in a way that doesn’t make her defensive. Tell your friend that you’re simply worried that until she went on this diet, she looked and seemed robust, but now she is pale, tired, and ill, and you think it’s time she got a second opinion about the course of treatment she’s on. Then if she won’t listen, you can be reassured you’ve done what you could.

Right, so, here’s the thing. Even when it’s your ‘friend’ it’s still policing. And, yes, telling people that they are making their allergies up is also policing. ‘Expressing your concern’ is policing. Whether someone’s a friend, coworker, or complete stranger, it is up to that person to approach you to ask for help, not to you to tell ou what to do.

And, you know, I have some friends whom I am pretty sure are receiving questionable medical care and possibly being taken advantage of. But it is not my business. If those friends approach me and ask me for my opinion, I will be honest, but until then? Not. My. Business. It is not my business to tell my friends how they should approach their medical care. Period. Just like it’s not Santa Cruz’ business to police this friend.

Another reader followed up, pointing out:

Joe (Chicago): Re: Restricted diet. If the person’s friend had a chronic illness like Crohn’s or ulcerative colitis, and then it turns out that she was ultimately diagnosed with celiac disease, her story wouldn’t be unusual. It’s often quite hard to figure out how to cope with a gluten-free diet, especially if you previously ate a lot of wheat-containing foods. The subsequent crappy diet (meaning not enough calories or carbohydrates) can often lead to weight loss, which itself can make people look like they’re sick.

Emily Yoffe: Good point. But it has become all the rage to declare everyone has a wheat allergy when they don’t. But anyone who is going on a “healthful” diet and ends up sicker needs to seek another medical opinion.

And again, Prudie went the ‘fake allergies’ route.

The thing about the fake allergies myth is that it kills people. This widespread belief that most people are just ‘making it up’ means that people do things like thinking it’s ‘not important’ if a few nuts end up in a dessert destined for someone who specifically said that ou was allergic to nuts. It’s just made up, right? Or, worst case scenario, maybe that person’s skin will break out a little, right?

What this person asked for was a free pass to police her ‘friend.’ And that’s exactly what she and readers got from Prudence, along with a healthy side of ‘oh, allergies are just made up anyway to be trendy or something.’

About s.e. smith

s.e. smith is a recalcitrant, grumpy person with disabilities who enjoys riling people up, talking about language, tearing apart poor science reporting, and chasing cats around the house with squeaky mice in hand. Ou personal website can be found at this ain't livin'.
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Hello there! I’ve arrived here after reading Annaham’s most recent guest post over at Tiger Beatdown, having never before heard of this blog! And I am very excited to be here!

This being the first ever article I have read on this blog, I do feel a bit presumptuous replying/commenting already. But I am genuinely confused! My guess is that, this being a blog about people/women with disabilities and/or chronic illnesses/pain/etc, the concept of “policing” is frequently discussed (this is an assumption), but it’s not one I’m totally familiar with. So forgive me if my question/confusion/comments seem ignorant. I am trying to figure this out!
Here’s my deal: I am someone who has always felt a desire/responsibility to take care of the people around me–“take care of” mostly in an emotional sense. For example, I constantly present myself to people as someone they can “always call if they need ANYTHING, regardless of time of day or anything else.” I often go out of my way to approach someone who looks like they’ve been crying and see if there’s anything I can do (including just listen). In my eighteen years on this planet, I’ve made a lot of really close friends who think this is my best quality–my willingness to bend over backwards for just about anyone I remotely care about in order to make them feel better. (This same quality of mine has been a source of overwhelming anxiety and has caused me to often feel that I spend so much energy caring for other people that I’ve got none left to care for myself–but that’s a whole different can of worms.)

I have to be honest, if the person in the first example were my friend, since there seems to be a regular dialogue there, I’d have no issues with sharing my observations – though I’d keep them clinical and I wouldn’t offer any advice. Though I don’t consider telling someone I know and care about that I’ve concern for their well-being or health ‘policing’.

Talk of ‘fake’ allergies annoys me, because it leads to misunderstandings that have led to deaths. More often, the person isn’t making up the result that they were given in an allergy test when they say they are allergic – however, the tests have been proven to be unreliable and have led to overdiagnosis of food allergies, which is just as dangerous and has led to the idea that people make them up ‘to be trendy’.

i think the line between “policing” and “probing further in a caring way with a friend” is very fine in a situation like this. in my mind, the difference is the expectation in the person’s mind – are they expecting that their questioning will lead to a change in the friend’s behavior? or are they expecting to express their love and support for a friend, regardless of whether that friend changes behavior or not after the conversation?

as someone who has been on the receiving end of “probing further in a caring way with a friend” i know it’s very easy for me to hear/experience that as policing, as judgment on my decisions, as policing. that’s been true even when is genuine concern and not judgment motivating the person talking to me. so that line may not be the same for both people in a conversation.

this is why, when i have these conversations with friends i’m worried about, i am always explicit about my love and support for them, and how that is not conditional on them agreeing with me, taking my advice, or changing their behavior in any way. to me, that’s what distinguishes policing from caring for a friend.

Policing vs Caring – Policing implies that the other party is passive and ignored. Caring? You listen to me, especially if I thank you for your concern, but that’s enough. (Or whatever fits the situation – lately for me it has been my mom and her friends researching doctors and medicines, so I told them I appreciated their concern, but the information overload stressed me out, so could they please stop.)

I guess caring is more interactive.

Food allergies – I’m so lucky, I’m allergic to the air right now (effing pollen), but no food allergies. But if I claimed I did (and no one knew the truth) how would that hurt anybody?* (some) People are willing to accommodate fad diets, so why not allergies?

*I understand it will hurt if people do find out – say I claim I’m allergic to peanuts while wearing my pb&j sandwich – because if one person fakes it, then they all do. Logic! /sarcasm

I do think one thing to consider that might make me say something to the friend here where I wouldn’t in almost all other situations is the particular issues our society has around weight loss. I know from my own experience that so, so few people think weight loss can ever be bad when they see it in their friends and family and just assume that everything must be great as long as you’re losing weight. And that attitude can be kind of poisonous. I don’t know the best way to approach it but somehow some kind of gentle notice to your friend that you’re willing to listen if, despite losing weight, she isn’t feeling great or her problems don’t seem to be disappearing, and she wants to vent about it feels like it might be a good idea.

Of course, we know nothing about the dynamics of the LW’s relationship with the friend.

That doesn’t make Emily Yoffe’s answer(s) right by any means. Maybe she feels like there are too many “fakers” and is out to make everyone go, hmm, he’s not really allergic to nuts, let me test.

In one book I have, there’s this really weird passage early on about food allergies. (Schooled by Anisha Lakhani) The main character is starting a job at a private school and is going over her students’ files. One kid is allergic to nuts, and she is told, “acute, life-threatening peanut allergies. You are responsible if so much as a peanut, or anything in the vicinity of a peanut, enters the classroom. He could die.”

Her reaction a page later? “an overindulged* child who would probably think nothing of the sacrifice I would have to make in giving up my peanut M&Ms addiction lest I so much as breathe on him.” I can’t figure out if it’s sarcasm or a sign of how evil the prep school environment is making her, because it makes no sense whatsoever.

I think there’s a critical line in this letter: ‘she says she feels great.’

So, we know that Friend has asked her about it and received a response. What the writer’s asking for here is for permission to push and pry; the writer’s not asking ‘can I care about my friends’ or ‘should I just say nothing at all if my friend looks sick,’ ou’s saying ‘hey, I thought my friend looked sick and I asked and my friend said she was fine but I think she’s not so I am totally entitled to be pushy about it, right?’ It’s essentially concern trolling; all we know about this situation is that the friend has seen a doctor (a private relationship) and that her physical appearance seems to be changing (also private), and that she has said she feels great, no matter what she looks like.

It is not uncommon for people with conditions like Crohn’s, or irritable bowel, or celiac to go through a transition phase after diagnosis where they lose weight and experience other physical changes. Because they’re adjusting to a new diet, and possibly to other lifestyle changes.

They are fully aware that they might ‘look’ sick, and being reminded of it by concern trolling friends is, in my opinion, not very helpful.

By all means, it’s appropriate to say ‘I see you’re going through some changes, and I love you, and if you ever want to talk about it, I am here for you.’ What’s not appropriate is to keep pressing after you’ve been answered, and that’s what I am getting at with this post.

By all means, it’s appropriate to say ‘I see you’re going through some changes, and I love you, and if you ever want to talk about it, I am here for you.’ What’s not appropriate is to keep pressing after you’ve been answered, and that’s what I am getting at with this post.

That is such a fine line, and I think on some level many of us feel free to throw ourselves across it when it is someone we care about. We feel entitled. I know I am guilty of doing such things when it was my mother, who has Crohn’s, and I thought that I had the right to lecture her about her decisions to follow or not follow her doctor’s advice. It makes us feel righteous because we care about them so we must be doing the right thing. But when that person is going through this rough and life changing transition I can tell you that it doesn’t help them. The only person it helps is the policing friend/family member/person. Because we feel like we did something good. And now that other person might feel like crap (or even more crap) because on top of their life having to be changed we have just laid all of that on them.

I’ve been on the receiving end of policing too, when I was in the heyday of my eating disorders. All that policing did was remind me that I was failing to gain control of this situation…which was kind of the point. I was trying to gain control. The concern trolling was hurtful. That is a delicate situation, dealing with an obvious shift in weight, and like s.e. said, it comes with most diet changes. But like abbyjean said, a simple “if you would like to talk about anything” is just about the perfect thing to offer.

Pallor, fatigue, weight change, and GI symptoms can all be symptoms of certain chronic illnesses. They may not necessarily be due to the diet, but rather to the condition itself. In my experience, it’s quite common for onlookers to confuse the symptoms of certain kinds of conditions with side effects of treatments. That’s why it’s so important to take self-reports like “I feel great” (or “I feel crap”, as the case may be) seriously.

It’s one thing to ask if a friend wants any support, or how they are finding things. But it’s not fair to assume that, as an onlooker, you have all the information.

It’s fine to let a friend know you are there for them if they need to vent, but telling a chronically ill friend that they look unhealthy is just mean and uncalled for, especially if she’s been feeling better and says so.

This is also a pet peeve of mine; food allergies are real. Celiac disease is real, and just because some people are jumping on GF diets as a bandwagon and claiming that wheat is the root of all evil does NOT mean that some of us have a real intolerance.

I’ve approved your comment, although as you can see I’ve edited it. To answer the gist of your question, I think the best thing to remember is that other people’s bodies aren’t about you. If someone doesn’t want to talk to you about stuff, then they don’t, and they don’t really owe it to you to bring you into the loop.

The other thing I will mention is to please review our comments policy. Most specifically, I’m thinking of the length of comments. The reason we ask people to not make comments longer than around 400 words is because individual FWD contributors must approve each comment, and lengthy comments tend to be difficult for various contributors to read. We don’t mind personal stories, and have certainly approved comments that are longer than that, but we tend to do so when they are personal stories by people with disabilities. (And then, not always, because again, they can be difficult for contributors to read over a certain length.)

And, I would note, for other commenters! Walls of text in the comments section can be intimidating and difficult for people to process when they are trying to read all of the comments on a post so that they can fully engage with the discussion.

*facepalm* If I had a dime for every time someone’s said, “You don’t have anaphylaxis with your food allergies, so they don’t exist…”

I’m really upset that people are so willing to minimize and trivialize what very well could be part of a larger diagnosis, as mine is, and it sounds like the original person’s is. More than that, who died and made Prudie an expert on “wheat allergies” and “faking allergies?”

On a less angry note, I’m used to people policing me, forcing me to prove what’s going on with my health and to hear someone encouraging that behavior is worrisome, to say the least. My goal in my own life is not to police others, but also not to lose it on those who decide they know better.

And yes, I do think that the “well meaning friend” and Prudie are both policing this unknown woman.

@Annie: I have gotten similar responses to my soy protein allergy, especially – unfortunately – from some particularly dense veg*ns. Why do allergies not count because they cause severe gastric distress and faintness (if I accidentally eat a lot of soy), or hives or eczema? It makes me incredibly cautious about what I eat and where, which makes eating at my in-laws (who use a lot of convenience foods) pretty tricky.

@Lizzie: While you might feel you’re being helpful, honestly? If I were crying or looked visibly upset, I would not be cool with a stranger wanting me to tell them all about it. I am not cool discussing how I feel with anyone beyond my husband, my brother, usually my parents, usually my preferred chronic conditions support group, and usually my best friend. These people, who are safe, will trust me to ask for help when I need it. Strangers or acquaintances essentially demand that I reassure them or tell them I’m okay, which takes energy I. don’t. have.

I know that I can get annoyingly pedantic about the distinctions among allergy and sensitivity and intolerance, but I try to keep that to myself unless it’s a relevant reply to something said by the person who has the issue. If someone tells me “I’m allergic to X,” then the useful information that I get from that is “Don’t offer this person any food containing X.” Anything beyond that is only my business if the person it concerns wants to talk to me about it.

I have multiple food allergies (or “sensitivities” if you want to be technical about it — only a few are “true allergies” meaning IgE-mediated), as do almost all my friends with MCS. I think that’s part of the problem: people have a confusion between a sensitivity and an allergy (which is why allergists are notoriously dismissive about MCS and food sensitivities).

HOWEVER, as S.E. and other have noted, WTF cares? MYOB. Prudy’s response particularly pisses me off because 1. I have multiple disabilities that, in my case, are visible, but in many cases are not, and 2. I went through years of friends/family/strangers/doctors thinking x, y, z was “fake.” AND 3. one dear friend who has multiple food sensitivities/GI issues is very underweight, which is extremely upsetting for her. It’s a constant struggle to eat enough without getting sick, and being underweight has caused other medical problems. But “well-meaning” jerks and doctors like to “accuse” her of anorexia, etc. (Which, if she did have an eating disorder, would not be a helpful approach, either!)

The bottom line is that nobody can tell from how you look, how you FEEL. If the friend says she feels better, there has to be a reason for that. Maybe until she got some validation from this “quack” doctor, she was afraid to tell her “friend” how crappy she felt all the time. Urgh.

We’ve had things like this happen in our family, and my cousin had severe chemical sensitivities for a few years. She also got much weaker after she saw her first “nutritionist” or whatever he was (I use the quotes because a dietician is of necessity qualified in this country; anyone can call him/herself a nutritionist and there are a lot of quacks including some of the famous ones). I would say to this person that she should gently suggest to her friend that she get a second opinion on whatever is causing her allergy or sickness rather than try and force the issue.